Tanga Research Centre, National Institute for Medical Research, Tanga.
Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi.
Epileptic Disord. 2019 Oct 1;21(5):425-435. doi: 10.1684/epd.2019.1093.
To describe the clinical manifestations of epilepsy and access to antiseizure treatment in Mahenge in Central Tanzania, an onchocerciasis endemic area with a high prevalence of epilepsy. A door-to-door epilepsy prevalence survey was conducted in four rural and two sub-urban villages. Trained community workers used five screening questions to identify persons suspected to have epilepsy. Such individuals were interviewed and examined by a neurologist or a medical doctor with additional training in epilepsy, and were tested for Onchocerca volvulus antibodies. A total of 221 out of 8,062 (2.74%) surveyed individuals were confirmed to have epilepsy. The median age at seizure onset was 12 years (interquartile range: 7-16). Seventy-nine persons with epilepsy (PWE) (36.1%) had a family member with epilepsy, which was a sibling in 52.1%. Tonic-clonic seizures (142 individuals; 64.2%) were the most common seizure type. Nodding seizures were reported in 12.7% of PWE; the majority of them living in rural villages. Persons with nodding seizures reported more frequent seizures, presented with more psychiatric symptoms, and more often had onchocerciasis antibodies than those with other seizure types. The high rate of individuals with a seizure onset at between seven and 16 years is characteristic of onchocerciasis-associated epilepsy (OAE). Of the PWE, 77.9% met the criteria for the clinical case definition of OAE. Eighty-three PWE (37.6%) were not taking any antiepileptic medication. Phenobarbital was the antiepileptic drug most commonly prescribed in 76.1% of treated PWE. The high prevalence of epilepsy in rural villages in Mahenge most likely is related to the high prevalence of OAE. To prevent children developing OAE, strengthening the onchocerciasis elimination programme in Mahenge is urgently needed. Moreover, a decentralised epilepsy treatment programme is also needed to provide uninterrupted access to affordable antiepileptic drugs for the many PWE living in rural villages in the Mahenge area.
描述坦桑尼亚中部马亨格的癫痫临床表现和抗癫痫治疗的可及性，马亨格是一个盘尾丝虫病流行区，癫痫患病率很高。在四个农村和两个郊区村庄进行了逐户癫痫患病率调查。经过培训的社区工作者使用五个筛查问题来确定疑似癫痫患者。这些人由神经病学家或接受过癫痫额外培训的医生进行访谈和检查，并进行了旋毛虫抗体检测。在接受调查的 8062 人中，共有 221 人（2.74%）被确诊为癫痫。癫痫发作的中位年龄为 12 岁（四分位间距：7-16）。79 名癫痫患者（PWE）（36.1%）有癫痫家族史，其中 52.1%是兄弟姐妹。强直阵挛性发作（142 人；64.2%）是最常见的发作类型。有 12.7%的 PWE 报告有点头样发作；他们中的大多数人居住在农村村庄。有点头样发作的人报告发作更频繁，伴有更多的精神症状，并且比其他发作类型的人更常出现旋毛虫抗体。7-16 岁之间发病的患者比例很高，这是盘尾丝虫病相关癫痫（OAE）的特征。在 PWE 中，77.9%符合 OAE 的临床病例定义标准。83 名 PWE（37.6%）未服用任何抗癫痫药物。苯巴比妥是治疗 PWE 中最常用的抗癫痫药物，占 76.1%。马亨格农村地区癫痫患病率高，很可能与 OAE 患病率高有关。为了防止儿童发生 OAE，急需加强马亨格的盘尾丝虫病消除计划。此外，还需要一个分散的癫痫治疗方案，为马亨格地区农村地区的许多 PWE 提供负担得起的抗癫痫药物。
